Health plans and TPAs
Health plans are insurance policies that private companies or government programs offer to cover healthcare costs for enrolled individuals. Third-party administrators manage and process insurance claims for these health and employee benefit plans, often serving as intermediaries among healthcare providers, payers and beneficiaries.
Top Stories
-
News
03 Mar 2026
Brian Evanko to succeed David Cordani as CEO of Cigna
Evanko, currently COO of Cigna, will assume the chief executive role after Cordani retires in July. Continue Reading
-
News
25 Feb 2026
New report shows NSA is working. So, why are payers, providers still mad?
A new report suggests greater in-network participation since the No Surprises Act, but more work needs to be done to iron out the law's wrinkles for major stakeholders. Continue Reading
-
News
31 Jul 2019
Expanding Medicare Supplemental Benefits to Benefit Seniors
With fewer Medicare beneficiaries receiving supplemental coverage through employer-sponsored insurance, Medicare’s supplemental benefits should expand. Continue Reading
-
News
24 Jul 2018
Generic Drugs Could Have Saved $3B for Medicare Part D Program
The Medicare Part D program could have saved $3 billion in 2016 if the payer encouraged generic drug substitution over the use of brand-name therapies. Continue Reading
-
News
29 May 2018
Preventing Provider Fraud through Health IT, Data Analytics
Payers that want to improve their ability to detect and react to provider fraud must invest in health IT and data analytics solutions to flag criminal activity. Continue Reading
-
News
07 Jun 2017
Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit
Freedom Health and Optimum Healthcare have been ordered to pay $32.5 million for systemic Medicare Advantage fraud alleged by a whistleblower lawsuit. Continue Reading
-
News
23 May 2017
Understanding the Basics of Accountable Care Organizations
Since their inception, accountable care organizations (ACOs) have blazed a path of innovation in the healthcare industry, from delivery to quality of care. Continue Reading
-
Feature
13 Jan 2017
How Payers Can Improve HEDIS Quality Measure Performance
Population health management, health IT investment, and provider engagement need to be targeted to improve HEDIS quality measure performance. Continue Reading
-
Answer
07 Oct 2016
How Medicare, Medicaid, and CHIP Guide the Health Payer Industry
Public coverage programs like Medicare, Medicaid, and CHIP are leading the way in value-based care payment models. Continue Reading
-
News
05 Jul 2016
Why HEDIS Quality Measures Matter for Value-Based Care
HEDIS measures are being followed by public health payers that are moving into the value-based care sphere as well. Continue Reading
-
News
30 Dec 2015
The History and Evolution of CHIP and the Medicare Program
When Lyndon B. Johnson took the presidency in 1964, the Medicare program was finally established as a system to provide healthcare coverage to elderly citizens around the nation. Continue Reading